Vasoplegia After Restrictive Mitral Annuloplasty for Functional Mitral Regurgitation in Patients With Heart Failure.

Abstract

OBJECTIVES:

Patients undergoing heart failure surgery are at risk for developing postoperative vasoplegia. The aim of this study was to determine the incidence, survival, and predictors of vasoplegia in heart failure patients undergoing mitral valve repair for functional mitral regurgitation and to evaluate the effect of ischemic versus non-ischemic etiology.

DESIGN:

Retrospective.

SETTING:

University medical center, single institutional.

PARTICIPANTS:

Heart failure patients with functional mitral regurgitation who underwent restrictive mitral annuloplasty (2006-2015).

MEASUREMENTS AND MAIN RESULTS:

One hundred twenty-two patients were included (48% ischemic etiology). The incidence of vasoplegia was 19% and was not influenced by mitral regurgitation etiology. Ninety-day survival rate was decreased in vasoplegic compared with non-vasoplegic patients (65% v 93%, p < 0.001). After adjusting for age, gender, and heart failure etiology, prior hypertension (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.08-0.91; p = 0.034), higher creatinine clearance (OR 0.97; 95% CI 0.95-0.99; p = 0.009), and beta-blocker use (OR 0.25; 95% CI 0.09-0.73; p = 0.011) decreased the risk of vasoplegia. Anemia (OR 3.00; 95% CI 1.10-8.20; p = 0.032) and longer cross clamp (OR 1.03; 95% CI 1.01-1.04; p = 0.001), cardiopulmonary bypass (OR 1.01; 95% CI 1.00-1.02; p = 0.003), and procedure times (OR 1.01; 95% CI 1.00-1.02, p = 0.002) increased the risk of vasoplegia.

CONCLUSIONS:

Vasoplegia occurs in 19% of heart failure patients undergoing mitral valve repair for functional mitral regurgitation. It is associated with a poor early outcome. Prior hypertension, a higher creatinine clearance, and beta-blocker use were associated with a decreased risk of vasoplegia, whereas anemia and longer procedure times were associated with an increased risk of vasoplegia, independent of heart failure etiology.

• Authors: Marieke E van Vessem, Annelieke H J Petrus, Meindert Palmen, Jerry Braun, Martin J Schalij, Robert J M Klautz, Saskia L M A Beeres
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 33 Issue 12 Pg. 3273-3280 (Dec 2019) ISSN: 1532-8422 [Electronic] United States
• PMID: 31350152 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Topics

• Aged
• Echocardiography
• Female
• Follow-Up Studies
• Heart Failure (diagnosis, physiopathology)
• Humans
• Incidence
• Male
• Middle Aged
• Mitral Valve (diagnostic imaging, surgery)
• Mitral Valve Annuloplasty (methods)
• Mitral Valve Insufficiency (complications, diagnosis, surgery)
• Netherlands (epidemiology)
• Postoperative Complications
• Prognosis
• Retrospective Studies
• Survival Rate (trends)
• Vasodilation (physiology)
• Vasoplegia (epidemiology, etiology)
• Ventricular Function, Left (physiology)
• Ventricular Remodeling